Some Senate Dems mum on Medicaid

There may be more to read from what wasn’t included in Sen. Jay Rockefeller’s letter to the White House last week than what was in it.

Multiple letters released June 9 — designed to show that Senate Democrats won’t support efforts to dismantle Medicaid — didn’t mention the Republican proposals to repeal the program’s maintenance of effort provisions. And they didn’t include 12 Democratic senators who some worry may be persuaded to join Republican efforts to chip away at the program.

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Although advocates publicly hailed the new show of support for Medicaid, there are still lingering fears about future funding for the federal-state health care program.

They may have reason to worry. Some of the Democrats who didn’t sign a letter aren’t exactly voicing rock-solid opposition to Medicaid block grants, and at least one — Joe Manchin of West Virginia — is suggesting he could support them.

“The good news is that there are 41 people” who signed the letters, one Medicaid advocate told POLITICO. “The bad news is it took them a long time to get there, and it took a lot of effort to get them there.”

The letters were designed to show how strongly Democrats support Medicaid, which Republicans have proposed overhauling and cutting by more than $750 billion over 10 years in their budget proposal.

The House budget proposal would convert Medicaid into a block grant program, sending federal money to states with fewer restrictions on its use.

Republicans argue block grants would give states flexibility to alter the program based on their unique needs, but Democrats worry states would slash the program’s benefits.

“Since 1965, the federal government has helped states pay for the basic health care and long-term services low-income Americans need,” Rockefeller’s letter to President Barack Obama reads. “A cap on federal funding or block grant would undermine this federal commitment. We are unwilling to allow the federal government to walk away from Medicaid’s 68 million beneficiaries, the providers that serve them and the urban and rural communities in which they live.”

Four other Democrats sent similar letters to the president.

While Democrats have pounced on the GOP’s Medicare plan through countless press conferences, news releases and advertisements, they’ve been slower to mount a Medicaid defense.

The filibuster-proof 41 signatures prove that a large-scale Medicaid overhaul is not likely to pass. But a close look at the letters shows the program is vulnerable to other changes.

The letter doesn’t mention Republican attempts to repeal Medicaid’s maintenance of effort provisions, which bar states from paring back Medicaid eligibility standards. If such a vote were to come up in the Senate — or in budget talks — it may be a difficult proposal for some moderate Democrats from budget-strapped states who are up for reelection in 2012.

“It’s definitely noteworthy,” the Medicaid advocate said. “MOE is a little more controversial. … I think they didn’t put it on there for a reason. It would have been harder to get 41 signatures.”

Rockefeller explained the maintenance of effort absence by saying it is merely a part of Medicaid, which the letter clearly addresses.

“The maintenance of effort is huge because if that is taken out, it means the governors don’t have to meet any of their rules or disciplines from the federal government, which are put there for a very good reason,” Rockefeller said.

The absence of 11 Senate Democrats and Connecticut independent Joe Lieberman from the letters is another noteworthy omission.